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Research Project: Pediatric Clinical Nutrition

Location: Children's Nutrition Research Center

Title: Children with poor linear growth are at risk for repeated relapse to wasting after recovery from moderate acute malnutrition

item STOBAUGH, HEATHER - University Of Washington
item ROGERS, BEATRICE - Friedman School Of Nutrition
item ROSENBERG, IRWIN - Friedman School Of Nutrition
item WEBB, PATRICK - Friedman School Of Nutrition
item MALETA, KENNETH - University Of Malawi
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)
item TREHAN, INDI - University Of Washington

Submitted to: American Society for Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/30/2018
Publication Date: 5/3/2018
Citation: Stobaugh, H.C., Rogers, B.L., Rosenberg, I.H., Webb, P., Maleta, K.M., Manary, M.J., Trehan, I. 2018. Children with poor linear growth are at risk for repeated relapse to wasting after recovery from moderate acute malnutrition. American Society for Nutrition. 148:974-979.

Interpretive Summary: There may be a connection between malawian children who are both short and underweight for their age. Information from children who recovered from malnutrition in the last year was studied for these connections. It was discovered that children who experience poor growth after recovering from malnutrition are more likely to become malnourished again. Further research is needed to better understand the underlying issues associated with these findings.

Technical Abstract: Nutrition programs frequently approach wasting and stunting as 2 separate conditions with distinct causes and effects. Although several cross-sectional studies have identified an association between the 2 conditions, longitudinal studies are useful to quantify the risk of acute malnutrition based on the trajectory of linear growth. We analyzed data from a longitudinal study to explore associations between linear growth and relapse to acute malnutrition in high-risk children during the year after recovery from moderate acute malnutrition (MAM). This was a secondary data analysis from a cluster randomized trial involving 1487 Malawian children 6–62 mo old treated for MAM and enrolled upon recovery. Children were followed for 1 y, during which data were collected on anthropometric progress, symptoms of illness, and household food security. Multivariate fixed-effects logistic regression was used to identify associations between linear growth and relapse to acute malnutrition. Children who have recovered from MAM proved to be a high-risk population, with nearly half experiencing a decrease in height-for-age z score (HAZ) for 12 mo. Children whose HAZ was declining were more likely to relapse to MAM or SAM than were those whose linear growth rate maintained or increased their HAZ (P<0.001). Mean changes of +0.15, -0.03, -0.17, and -0.53 in HAZ were observed for those who sustained recovery, relapsed to MAM once, relapsed to MAM multiple times, and developed SAM, respectively. Our results add to the body of evidence suggesting that acute wasting is a harbinger of subsequent stunting. Children who experience poor linear growth after MAM are more likely to experience relapse. Given this bidirectional relation between wasting and stunting, supplementary feeding programs should consider both when designing protocols, aiming to optimize linear growth and achieve acute weight gain, as a means of reducing relapse.